The number of removed axillary sentinel lymph nodes and its impact on the diagnostic accuracy of sentinel lymph node biopsy in breast cancer


Authors: O. Zapletal 1;  O. Coufal 1,2;  I. Selingerová 3;  P. Krsička 1,2;  P. Vrtělová 1,2
Authors‘ workplace: Masarykův onkologický ústav – Oddělení chirurgické onkologie a operačních sálů, primář: MUDr. Z. Eber 1;  Masarykův onkologický ústav – Klinika komplexní onkologické péče, přednosta: Prof. MUDr. R. Vyzula, CSc. 2;  Masarykova univerzita – Ústav matematiky a statistiky Přírodovědecké fakulty ředitel: Prof. RNDr. J. Rosický, DrSc. 3
Published in: Rozhl. Chir., 2013, roč. 92, č. 1, s. 21-26.
Category: Original articles

Práce byla podpořena Evropským fondem pro regionální rozvoj a státním rozpočtem České republiky (OP VaVpI – RECAMO, CZ.1.05/2.1.00/03.0101).
Práce byla podpořena projektem A-Math-Net Síť pro transfer znalostí v aplikované matematice (CZ.1.07/2.4.00/17.0100)

Overview

Introduction:
The number of lymph nodes removed during the sentinel lymph node biopsy in patients with breast cancer usually ranges from 1 to 3. In some cases, multiple nodes are identified and removed, which could be associated with increased risk of postoperative morbidity. The objective of the study was to assess the number of sentinel lymph nodes removed in patients treated in our hospital, to analyze factors that may influence the amount of the removed nodes, and to find if there is an upper threshold number of lymph nodes that should be removed without sacrificing the diagnostic accuracy of the sentinel lymph node biopsy.

Material and methods:
Clinical data of four hundred and forty (440) breast cancer patients who underwent sentinel lymph node biopsy in Masaryk Memorial Cancer Institute during the year 2011 were retrospectively collected and analyzed.

Results:
The number of sentinel lymph nodes ranged from 0 to 9 (average 1.7, median 1). The number of sentinel lymph nodes was significantly influenced by the age of the patient, the operating surgeon and the laterality of the surgery. In 275 cases the sentinel lymph nodes were negative, in the other cases macrometastases (n = 101), micrometastases (n = 46) or isolated tumor cells (n = 17) were found. In all the cases, but one, the staging of the axilla was determined by the status of the first three sentinel lymph nodes removed. Only in one case the first detected macrometastasis was present in the fifth node.

Conclusion:
In the vast majority of cases, the first three sentinel lymph nodes are sufficient to accurately assess the axillary status. However, with respect to the described case of first detected metastasis in the fifth node, to the present literary data and to the variability of clinical situations, we generally recommend to remove all lymph nodes meeting the criteria of the surgical definition of sentinel lymph node.

Key words:
breast cancer – sentinel lymph node biopsy – false negativity – postoperative morbidity – lymphedema.


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Surgery Orthopaedics Trauma surgery
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